title: Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy.
abstract: BACKGROUND
  Thromboelastometry (TEM)-guided haemostatic therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in trauma patients may reduce the need for transfusion of red blood cells (RBC) or platelet concentrate, compared with fresh frozen plasma (FFP)-based haemostatic therapy.
  
  
  METHODS
  This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving ≥ 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission ≥ 2 mmol/L, injury severity score (ISS) ≥ 16, abbreviated injury scale for thorax and/or abdomen and/or extremity ≥ 3, and for head/neck < 5.
  
  
  RESULTS
  For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 ± 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 ± 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69).
  
  
  CONCLUSIONS
  TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products.
authors.affiliation: Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Donaueschingenstrasse 13, A-1200 Vienna, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nienaber
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.forename: Gerald
authors.initials: G
authors.lastname: Hochleitner
authors.forename: Florian
authors.initials: F
authors.lastname: Primavesi
authors.forename: Beatrice
authors.initials: B
authors.lastname: Steitz
authors.forename: Christian
authors.initials: C
authors.lastname: Arndt
authors.forename: Alexander
authors.initials: A
authors.lastname: Hanke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
chemical_list: D005340:Fibrinogen